Patients with this debilitating virus produce 440 gallons of medical waste daily, including instruments, gowns, gloves, body fluids, sheets, mattresses and more. That’s a substantial amount of medical waste in any situation, but it’s especially daunting in this case because it needs to be disposed of extremely cautiously, to avoid the risk of spreading infection. What do you do with a problem like Ebola waste? Because you don’t want to toss it in the garbage.

Somewhat surprisingly, says Bausch, the United States actually faces bigger problems when it comes to safely disposing of Ebola waste, which is simply burned in large pits in Africa: “In the United States, of course, we are somewhat beholden to higher tech solutions, which in some ways are a little bit more problematic in terms of treating all that waste, and we need autoclaves or incinerators that can handle that sort of thing. It’s not the actual inactivation that’s particularly difficult; it’s just the process of getting the waste from, of course, the frontline of care and interaction with the patients safely to the place where it can be incinerated or autoclaved.”

The problem in the United States is ironically compounded by the increased access to medical care, and the higher quality of medical services, available. In the United States, patients are treated by medical teams with access to a huge volume of supplies they use for protection, including masks, gowns, booties, and gloves, along with sanitizers and other tools. Moreover, patients receive extensive medical interventions that generate waste like needles, tubing, medical tape, empty IV bags, and more. The very care that has helped most of the handful of Ebola patients in the United States conquer the disease has contributed to the huge amount of waste generated, highlighting a critical hole in U.S. medical infrastructure — while African hospitals may have lacked the supplies and personnel needed to supply aid to Ebola patients, they’re at least prepared to handle the waste.